World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders - first revision.
In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, World J Biol Psychiatry 3:171), recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo- or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.
Bandelow
Borwin
B
Department of Psychiatry and Psychotherapy, University of Gottingen, Gottingen, Germany. Sekretariat.Bandelow@med.uni-goettingen.de
Zohar
Joseph
J
Hollander
Eric
E
Kasper
Siegfried
S
Möller
Hans-Jürgen
HJ
Zohar
Joseph
J
Hollander
Eric
E
Kasper
Siegfried
S
Möller
Hans-Jürgen
HJ
Bandelow
Borwin
B
Allgulander
Christer
C
Ayuso-Gutierrez
José
J
Baldwin
David S
DS
Buenvicius
Robertas
R
Cassano
Giovanni
G
Fineberg
Naomi
N
Gabriels
Loes
L
Hindmarch
Ian
I
Kaiya
Hisanobu
H
Klein
Donald F
DF
Lader
Malcolm
M
Lecrubier
Yves
Y
Lépine
Jean-Pierre
JP
Liebowitz
Michael R
MR
Lopez-Ibor
Juan José
JJ
Marazziti
Donatella
D
Miguel
Euripedes C
EC
Oh
Kang Seob
KS
Preter
Maurice
M
Rupprecht
Rainer
R
Sato
Mitsumoto
M
Starcevic
Vladan
V
Stein
Dan J
DJ
van Ameringen
Michael
M
Vega
Johann
J
D001008:Anxiety Disorders / Q000188:drug therapy* / Q000453:epidemiology; D001689:Biological Psychiatry / Q000592:standards*; D004358:Drug Therapy / Q000592:standards*; D014943:Global Health; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy* / Q000453:epidemiology